Obstructive Sleep Apnea (OSA)
Have you been diagnosed with Obstructive Sleep Apnea? Do you wake up in the morning feeling as if you hadn’t slept at all? Do you have issues with snoring, daytime sleepiness, fatigue, and low energy? Has your sleep physician talked to you about your higher risk of hypertension, heart attack, stroke, congestive heart failure, arrhythmias, and sudden death.
If you dislike your CPAP machine and are looking for an alternative we can help! Dr. Foretich, with his extensive experience in all the alternative treatments for OSA, will help you get rid of your CPAP machine.
For more information about Bone Grafting or to schedule a consult with Dr. Foretich, please use our Appointment Request form or call our office in McLean, VA at McLean Office Phone Number 703-867-9499.
What is Obstructive Sleep Apnea?
All the symptoms and medical complications from Obstructive Sleep Apnea occur as a result of the tissues attached to the roof of the mouth and back of the tongue falling back on the back of the throat. This blocks the oxygen from going through.
Stacked graphic images showing Open Airways on top and Blocked Airways from Sleep Apnea on the bottomThe airway blockage results in a chain of events that leads to the complications below:
Obstructive sleep apnea results in multiple symptoms that affect the quality of life, including:
- Witnessed episodes of stopped breathing
- Excessive day time sleepiness
- Fatigue and low energy
- Memory loss
- Morning headaches
Obstructive sleep apnea is also implicated in multiple medical complications including:
- High blood pressure
- Cardiovascular disease/Heart attack
- Congestive heart failure
- Heart arrhythmias
- Sudden death during sleep
- Catastrophic automobile accidents
iTERO Digital Scanning Technology
The iTero Digital Scanning Technology allows the doctors to simply scan the teeth using a laser, thus eliminating the need for dental impression "mold" material (which is messy, tends to cause a gag reflex, and often must be repeated several times). This makes it easier than ever to receive non-invasive oral appliances that help in the treatment of Obstructive Sleep Apnea.
CPAP Alternative #1: Oral Appliance (worn during sleep only)
The oral appliance moves the lower jaw bone forward in space during sleep, therefore pulling the tissues behind the tongue forward. This creates the space needed for the patient to breath comfortably during the night.
Side effects from using the oral appliance include: temporary excessive salivation (likely), TMJ/facial discomfort (unlikely), damage to teeth like chipping or loosening (unlikely), and claustrophobia (unlikely).
The Success Rate is 85–90% in patients with mild-moderate sleep apnea who actually use the appliance and tolerate it. This is the chance of cure, with no further need for the CPAP machine. Some of the complications mentioned above are the reasons you may not tolerate the appliance.
It takes around 2–3 months of wearing the appliance in order to be ready for another sleep study to determine efficacy. This time is used to get used to wearing the appliance and advancing the position of the lower jaw, in order to open up the airway.
If the repeat-sleep study shows sufficient improvement, there may be no need for further treatment outside of wearing the appliance over night. If the appliance is not effective, and you still do not tolerate the CPAP machine, further discussion regarding curative surgical options will be necessary.
CPAP Alternative #2: Combination Surgery (Chin Advancement + Soft Tissue Surgery)
The chin advancement procedure moves the chin bone forward in space, therefore pulling the tissues behind the tongue forward. This creates the space needed for the patient to breath comfortable during the night.
The procedure involves only the chin segment of the lower jaw (mandible). The segment that bears the teeth is not affected by the operation.
There are two ways of performing the Chin Advancement procedure:
- Sliding Genioplasty: This is done in patients whose facial features can tolerate (and can even be enhanced) by advancing the whole chin including the bottom border.
- Genioglossus Advancement: This is done in patients whose chin is already in a forward position and their facial features cannot tolerate an advancement of the chin. Instead, a smaller window of bone is moved forward that opens up the airway. This causes little or no aesthetic change in the face.
Your jaws will not be wired shut after the procedure and you will be able to open your mouth comfortably.
There are no restrictions on what kind of food you can eat after the surgery.
Complications from the surgery include: excessive bleeding (unlikely), infection (unlikely), temporary numbness of the lower lip and chin (likely), temporary swelling (likely), temporary feeling of tightness in the chin (likely).
When you combine this chin surgery with the palatal/tonsil/base of tongue surgery by the Ear, Nose, and Throat surgeon, the Success Rate is 70%. (Success Rate = the odds of OSA cure, with no further need for the CPAP machine).
Recovery from the surgery: The pain after the surgery is very well controlled with medications. The swelling will increase for 2–3 days, then stabilize and start regressing. Most of the swelling is gone after 2 weeks, while the residual swelling will take a few more weeks to subside.
For more information or to schedule a consult with Dr. Foretich, please call us: McLean Office Phone Number 703-867-9499.
CPAP Alternative #3 : Corrective Jaw Surgery (Maxillo-Mandibular Advancement, or MMA)
The upper and lower jaw advancement procedure moves both jaws forward in space, therefore pulling the tissues behind the roof of the mouth (palate) and tongue forward. This creates the space needed for the patient to breath comfortably during the night.
Complications from the surgery include: excessive bleeding (unlikely), infection (unlikely), temporary numbness of the cheeks, lips and chin (likely), temporary swelling (likely).
The vast majority of time, your jaws will not be wired shut after the surgery, and you will be able to open your mouth without restrictions.
Nutrition: You will be eating a non-chew diet after the procedure (noodles, scrambled eggs, rice … food that is cut into small enough pieces as to be eaten using only the lips, roof of the mouth, and tongue) for 6 weeks.
The Success Rate is 90–95%. This is a strong chance of OSA cure, with no further need for the CPAP machine.
Recovery from the surgery: The pain after the surgery is very well controlled with medications. The swelling will increase for 2–3 days, then stabilize and start regressing. Most of the swelling is gone after 2 weeks, while the residual swelling will take a few more weeks to subside. The numbness will gradually improve for several weeks to months after the procedure. You can eat soft, non-chewable foods such as mashed potatoes, scrambled eggs, rice, etc. (as long as you don’t need to put your teeth together to crush the food).
Call our office if you have any questions or would like to schedule an appointment: McLean Office Phone Number 703-867-9499.